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The Optimal Ileal Pouch: Physiologic Parameters Significantly Correlate with Overall Pouch Function

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Ileal pouch function is affected by several patient factors and pouch physiology. The significance of pouch physiology on optimal pouch function has not been well characterized. The purpose of this study was to examine specific post-ileal pouch anal anastomosis (IPAA) physiologic parameters to determine impact on pouch function and quality of life.

Methods

Patients undergoing proctocolectomy with IPAA for ulcerative colitis were examined. Post-IPAA compliance, pouch anal pressure gradient (PAPG), and function were assessed 6–8 months postoperatively. Compliance was calculated as change in volume divided by change in pressure. PAPG was calculated as the difference between anal pressure and intra-pouch pressure at a fixed volume. Pouch function evaluation included stool frequency and episodes of incontinence. Quality of life was evaluated using the Rockwood Fecal Incontinence Quality of Life Scale.

Results

A total of 125 patients were investigated. Post-IPAA resting anal pressure averaged 58.1 ± 15 mmHg. Mean volume and intra-pouch pressure at evacuation were 245 mL and 33.9 mmHg, respectively. Compliance averaged 11.2 mmHg/mL with a mean PAPG of − 29.3 mmHg. Compliance and PAPG correlated with 24-h (p = 0.003, p = 0.004) and nighttime stool frequency (p = 0.04, p = 0.03). Daytime continence was impacted by compliance (p = 0.04), PAPG (p = 0.02), and resting anal pressure (p = 0.02).

Conclusion

This unique evaluation reveals a significant correlation between IPAA physiologic properties and function. Optimal function and quality of life depend in part on maintaining optimal pouch compliance and pressure differentials between the pouch and anal canal, defined by the pouch anal pressure gradient.

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Authors and Affiliations

  1. Section of Colon and Rectal Surgery, University of Wisconsin-Madison, Madison, WI, USA

    Joseph C. Melvin, Bruce A. Harms, Charles P. Heise, Glen E. Leverson & Evie H. Carchman

  2. Associates in Colon and Rectal Surgery, MountainStar Healthcare, St. Mark’s Colon and Rectal Surgery Residency, Salt Lake City, UT, USA

    Joseph C. Melvin

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  1. Joseph C. Melvin
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  2. Bruce A. Harms
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  3. Charles P. Heise
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  4. Glen E. Leverson
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  5. Evie H. Carchman
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Contributions

Joseph C Melvin, MD: conceptualization; data curation; formal analysis; methodology; writing, original draft; writing, review and editing.

Charles P Heise, MD: conceptualization; formal analysis; methodology; writing, original draft.

Glen E Leverson, PhD: formal analysis; methodology; writing, original draft; writing, review and editing.

Bruce Harms, MD: conceptualization; formal analysis; methodology; writing, original draft; writing, review and editing.

Evie Carchman, MD: conceptualization; data curation; formal analysis; methodology; writing, original draft; writing, review and editing.

Corresponding author

Correspondence to Joseph C. Melvin.

Ethics declarations

This study was approved by the University of Wisconsin Institutional Review Board (2015-1531).

Conflicts of Interest

The authors declare that they have no conflict of interest.

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This manuscript was a podium presentation at the American Society of Colon and Rectal Surgeons annual meeting in Cleveland, OH (June 1–5, 2019)- W29.

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Melvin, J.C., Harms, B.A., Heise, C.P. et al. The Optimal Ileal Pouch: Physiologic Parameters Significantly Correlate with Overall Pouch Function. J Gastrointest Surg 25, 1280–1286 (2021). https://doi.org/10.1007/s11605-020-04617-3

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  • DOI: https://doi.org/10.1007/s11605-020-04617-3

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